A major difference between the paediatric care provided in Europe and that provided in the US stems from the attitudes of
care providers toward newborn circumcision as a preventive health measure. In the US, the great majority of newborn boys (about
1.4 million annually) are circumcised, whereas in Europe, neonatal circumcision is rarely done. European countries consider
newborn circumcision an unnecessary surgical procedure which increases the costs of operating nationalised health systems,
whereas in the US, circumcision is generally considered a simple, rapid operation with medical benefits which accrue throughout
life.

Local foreskin problems and hygiene

Phimosis, balanoposthitis, and difficulty of ensuring adequate genital hygiene in uncircumcised boys have been best described
in the European literature.1-4 US anticircumcision groups claim that genital hygiene can easily be maintained as the foreskin naturally separates, but,
in reality, genital hygiene in uncircumcised boys has been shown to be poor, even in British and Scandinavian middle class
schoolboys.12

The prevalence of true phimosis (anatomic constriction of the preputial opening, which must be distinguished from adherent
foreskin) in published studies varies from 0.3% to 0.9%,5 but true phimosis requires circumcision later in life, when the procedure is more difficult, risky, and expensive.67 Balanoposthitis has been estimated to occur in 4% of uncircumcised boys, and incidence peaks at age 2 to 5 years.3 Although treatment can be conservative, late circumcision is often necessary for recurrent cases, and medical management
requires additional physician visits and treatment.

Cancer of the penis

The evidence that circumcision protects against penile cancer is overwhelming. In the US, incidence of penile cancer in circumcised
men is essentially zero (about one reported case every five years), but it is 2.2 per 100 000 in uncircumcised men (about
1000 cases are reported annually). On the basis of life table analysis, Kochen and McCurdy estimated that an uncircumcised
…